Health Committee on Nov. 30th, 2010

[The Chair, Conservative, Joy Smith]

Good morning, everybody. Welcome to the Standing Committee on Health. We're very pleased that you're here today. Pursuant to Standing Order 108(2), we're doing a study on injury prevention in Canada.

There is going to be a 10-minute presentation from each of our organizations.

We will begin with Jane Billings.

First of all, let me introduce who we have here. We have, from the Public Health Agency of Canada, Sylvain Segard, director general at the Centre for Health Promotion. We have Jane Billings, senior assistant deputy minister of the Planning and Public Health Integration Branch.

From the Department of Health, we have Athana Mentzelopoulos, director general of the Consumer Product Safety Directorate. And we have Denis Roy, project officer at the mechanical and electrical hazards division, Consumer Product Safety Directorate.

We have, from Safe Kids Canada, Pamela Fuselli, executive director.

Welcome to all of you.

We will begin with Jane Billings, senior assistant deputy minister.

[Jane Billings, Senior Assistant Deputy Minister, Planning and Public Health Integration Branch, Public Health Agency of Canada]

Good morning. Thank you, Madam Chair.

I want to thank this committee for the opportunity to speak, and to acknowledge this important examination into injury prevention.

The work of this committee constitutes a critical step to improving our ability to reduce rates of injury and to improving the health of our population.

I will provide a very brief overview of the size and scope of injuries in Canada, add context about who is involved in addressing this issue, and then describe how the Public Health Agency is contributing to the efforts of reducing injuries among Canadians.

Injury has been defined as damage to the body caused by the sudden transfer of energy that is beyond the body's resilience. That's a fairly unhelpful definition, if I may say so. I think most of us know what we mean here. Injuries may be intentional or unintentional. Unintentional injuries are caused by events such as motor vehicle collisions, falls, drowning, and poisoning. Intentional injuries are caused by violence, such as violence against children and women, and self-inflicted harm, sometimes leading to suicide.

They happen to Canadians in every setting: at home, at the arena, and at work. Many of these injuries are preventable. Injuries are an important health problem in Canada. They are the leading cause of death for Canadians between the ages of one and 44. This is for both unintentional and intentional causes. For every death there are 16 hospital admissions, and too many of these result in impairments and disabilities, such as blindness, spinal cord injury, and intellectual deficit due to brain injury. Unintentional injuries are responsible for the majority of these injuries.

Motor vehicle crashes are the leading cause of injury deaths for most age groups. However, in older adolescents and in youth, suicide ranks first. Interpersonal and family violence is also of concern. Finally, falls are the leading cause of non-fatal injuries, and they are especially frequent among older Canadians.

In addition to causing human suffering, injuries impose a large economic burden. A recent study by SMARTRISK, based on 2004 data, estimated that the total economic burden of unintentional injuries in Canada for all ages is $19.8 billion per year. This figure includes $10.7 billion in direct health care costs and $9.1 billion in indirect costs, including lost productivity due to premature death and disabilities.

Injuries affect health care utilization in other ways. Injuries contribute to crowded hospital emergency rooms. Emergency surgeries for serious trauma cases contribute to wait times for elective procedures. Injuries resulting in long-term impairments and disabilities impact workforce participation and overall productivity.

I would like to take you behind some of these statistics to discuss those most at risk. For infants up to one year, suffocation is most often the cause of injury death. Injuries of various natures continue to be the leading cause of death for children, teens, youths, and adults up to age 44. In 2005, three Canadian children died from injuries every day, for a total of more than 1,081 deaths each year, and over 34,000 children were admitted to hospital.

Motor vehicle collisions, falls, drowning, and poisoning are the leading causes of unintentional injury for children and youth. Most injuries to infants and young children happen at home. For older children and adolescents, many injuries are related to sports and recreational activities. Workplace injuries start to occur among older adolescents and youth as they enter the workforce.

For older adults, falls are an increasingly serious risk. In fact, a third of all seniors experience a fall every year, and falls account for more than half of all injuries among Canadians aged 65 years and over. Many factors contribute to these falls: from biological factors such as visual impairments and balance problems to environmental factors such as ice and snow as well as hazards in the home.

The data also show that Canadians living in northern communities, aboriginal individuals, and families of lower socio-economic status are most likely to suffer injuries. Unintentional injury rates are three to four times higher for aboriginal children than for other children in Canada. Suicide among youth is very high in first nations communities, with rates five to seven times higher than for non-aboriginal youth. Suicide rates among Inuit youth are eleven times the national average. These statistics are particularly troubling when we consider that more than half their population is under 25 years of age.

But injuries are preventable, and I am pleased to say that over the last few decades, injury death rates have been reduced dramatically—40% since 1980. Much of this impressive decline is due to reductions in fatalities caused by motor vehicle crashes. This is good news, and we are seeking to reduce other types of injuries in Canada by applying the lessons we learned from the success of our road safety efforts.

In a 2001 UNICEF Report on Canada, our country ranked 18th out of the 26 OECD countries that reported child injury death rates. We should turn to the leaders in the international community in order to learn about the best practices that have contributed to their low injury rates.

We already know much about many interventions that have been proven to work and are cost-effective. For example, reducing the speed of traffic in some circumstances can reduce the frequency of motor vehicle collisions. Wearing seat belts reduces the risk of injury for those collisions that do occur. I have two other examples drawn from the United States. Every dollar invested in installing and maintaining residential smoke alarms provides overall savings estimated at $65. Every dollar spent on child restraints and bicycle helmets can save nearly $30.

We must also, however, anticipate the challenges that face us in coming years. For example, by 2031, as baby boomers age, older adults will account for almost a quarter of the population, and direct health care costs for fall-related injuries in this population are projected at $4.4 billion. This is more than double the $2 billion cost of these falls in 2004, when only 13% of the population was older than 65.

What are we doing about this at the Public Health Agency?

First, let's recognize that injury prevention is not just a health issue. Preventing injury is a responsibility for many in different sectors, in numerous federal departments, and in all levels of government. I'll name just a few examples of federal actors outside the health portfolio: Transport Canada, with a key role in road safety; the National Research Council, which sets building codes and safety standards; and Labour Canada, which plays an important part in workplace safety. Provinces and territories are heavily engaged on many fronts, and several provinces and territorial governments have adopted injury reduction strategies in recent years.

There are also many non-governmental organizations engaged in injury prevention. Some, like Safe Kids Canada, represented here today, are fully dedicated to the issue. Others, like the Canadian Agricultural Safety Association, focus on specific areas of injury prevention. And still others, like the Canadian Red Cross and the Canadian Pediatric Society, include safety and injury prevention as one of the elements in their mandate.

How does the Public Health Agency fit in?

We see ourselves as an agent of change. We have access to a multi-faceted approach to surveillance and data collection, knowledge development and dissemination, as well as collaboration and coordination. I will explain each of these in detail.

Surveillance is the ongoing, systematic use of routinely collected health data to inform and guide timely public health action. The Public Health Agency of Canada uses data from a variety of sources to profile injuries. In addition, we gather data from two of our own programs: the Canadian incidence study of reported child abuse and neglect, and the Canadian hospitals injury reporting and prevention program, a computerized information system that collects and analyzes data on injuries to people, mainly children, who are seen at emergency rooms in eleven pediatric hospitals and four general hospitals in Canada.

The agency acts as a centre of expertise for knowledge development and dissemination on certain issues, and we develop and disseminate this knowledge to a wide range of audiences, from professionals and policy-makers to individual Canadians. For example, our Division of Aging and Seniors provides advice and support for policy development and conducts and supports research and education activities to reduce the number and severity of falls.

The agency provides support to and participates in the Public Health Network, of which I'm sure you've heard before from Dr. Butler-Jones; it is the network established by federal, provincial, and territorial governments following SARS to be a vehicle for different levels of government and experts to work together to improve public health. We have under PHN an expert group on chronic disease and injury prevention, which does a great deal of work in building the knowledge base, facilitating prevention efforts, strengthening capacity, and monitoring and evaluating.

Along with the work being done by the FPT bodies, the Public Health Agency of Canada plays a role in convening stakeholders from outside the government.

For example, in 2009, the Public Health Agency of Canada co-hosted an Injury Prevention Stakeholder Workshop, which was attended by 50 high-level leaders representing various levels of government and other sectors. The workshop resulted in the creation of a series of recommendations on how all parties could work together on collective efforts.

Thank you.

We would be pleased to respond to your questions.

[The Chair, Conservative, Joy Smith]

Thank you very much.

Now we'll go to Athana Mentzelopoulos, from the Department of Health.

[Athana Mentzelopoulos, Director General, Consumer Product Safety Directorate, Department of Health]

Thank you, Madam Chair, for the opportunity to appear today to discuss the consumer product safety-related aspects of the Public Health Agency's “Child and Youth Injury in Review, 2009 Edition”.

As you said, my name is Athana Mentzelopoulos. I'm director general of the Consumer Product Safety Directorate at Health Canada, and I'm accompanied today by Denis Roy. He is a mechanical engineer who works in the mechanical and electrical hazards division of my directorate.

The “Child and Youth Injury in Review” is an important publication for those who work in product safety. It helps to increase the public's awareness of the dangers that consumer products can pose, and it has helped us in our ongoing efforts to make products, and particularly children's products, safe.

Any product can pose a risk if it is used inappropriately. No doubt you have heard this truism in a variety of forms. Water, for example, is essential for life, but drinking a profound volume of water can be fatal. Equally so, no product can substitute for a parent or a caregiver.

In my area of work, one of our ongoing priorities is to inform consumers about the appropriate use of products. It is essential to follow manufacturers' instructions for use, for example. We also routinely issue reminders about safe use of and practices related to consumer products, and we frequently advise consumers about risks posed by consumer products, either as a result of their normal use or because of unseen or unintentional hazards.

Some recent examples of our work have been the series of warnings we have issued about the presence of lead and more recently of cadmium in children's jewellery. We have also continued to remind Canadians about safe sleep practices for infants, including the need to ensure that infants sleep in a crib that has been properly assembled and is free of bumper pads, pillows, and other decorations.

In the Consumer Product Safety Directorate, we regulate certain products and classes of products, and wherever we cannot sufficiently address and mitigate a risk through regulations, we have prohibitions. This is the case for, among other things, toys.

In Canada, safety requirements for toys are currently specified in the Hazardous Products Act and its associated regulations. Under this act, certain toys are prohibited, while others are restricted. There are requirements concerning the size of component parts of toys, allowable stuffing materials, and limits on the presence of lead and toxic substances, among other requirements.

It is the responsibility of manufacturers, importers, distributors, and retailers to ensure that they are complying with the Hazardous Products Act and the regulations. Product safety officers routinely monitor the marketplace and take appropriate enforcement action on toys and other products that contravene the legislation. We also have a laboratory, the product safety laboratory, that examines potentially hazardous products in order to assess the nature and degree of any hazards.

In our work on product safety we are attentive to the normal and foreseeable use of products. We consider dangers posed by consumer products to be those unreasonable hazards that are posed by a product during or as a result of its normal or foreseeable use and that might cause injury or death. There is a reasonableness standard that must be adhered to and that guides our work.

As many members here today know, Health Canada is currently proposing to change the legislative framework for consumer product safety. That legislation is now before a Senate committee.

As I mentioned, we currently work in the context of the Hazardous Products Act. That legislation is 40 years old and is a framework that only permits us to react to risks and hazards as they emerge through the preparation of regulations and prohibitions.

On the basis of this legislation, we have developed specific and very prescriptive regulations for toys, a prohibition on baby walkers, regulations for cribs and cradles, limits on the use of lead in children's products, requirements for teethers and rattles, and a prohibition on yo-yo balls, among many other things. All of these regulations and prohibitions will be transferred to the Canada Consumer Product Safety Act, should it pass, and the level of protection they afford will be maintained.

The proposed Canada Consumer Product Safety Act—the CCPSA—will fundamentally change and improve the way we approach product safety in Canada. Bill C-36, the CCPSA, includes a number of elements that will help us to further strengthen consumer safety. It has a general prohibition against consumer products that are a danger to human health or safety. It would also require industry to report product-related incidents and would give the government the authority for mandatory recalls. That's something I know members here are very familiar with.

These authorities all support a three-pillar approach to product safety: active prevention, targeted oversight, and rapid response. These are essential pillars to our program, because we have a post-market regulatory regime for consumer products in Canada. That means there is no requirement for certification or for approvals by government for industry before they introduce new products to the market.

We need the tools in the CCPSA so that we can generate product-related intelligence that will be the basis of an early warning system when problems with the product emerge. In the future, should the CCPSA pass, we will be able to act quickly and proactively at the first signs of emerging product-related problems. Rather than necessarily going through the process of developing regulations to deal with product-specific hazards, we will be able to use the general prohibition as part of our step-wise enforcement to act quickly when we have determined that a danger to human health or safety exists.

Given the post-market nature of the consumer product market, the rapid innovation in consumer products, and the insatiable desire for new products and new design, work in product safety is never done. The CCPSA is one element of the government's food and consumer safety action plan. Through that plan, we have also been resourced for more inspectors, more outreach work to consumers and industry, and more work in the area of standards development. Through its elements, the food and consumer safety action plan is building a consumer product partnership in which industry is more aware of its obligations for safe products, consumers have more information about the products they are purchasing, and government has more flexible and modern powers to help ensure safety.

The Hazardous Products Act has served us well over recent decades of work. We have a significant body of regulations and prohibitions, and we also have an aggressive work agenda for modernizing some of those regulations and for developing new ones.

Just yesterday, our minister announced new changes to regulations under the act that will restrict the amount of lead in a variety of consumer products, including children's toys. We are also currently involved in a project with the United States and the EU, and more recently Australia has joined, to improve safety standards for corded window coverings. Our requirements in Canada for these products are already among the strictest in the world, but we are working with our international partners to address certain hazards posed by Roman shades and by roll-up blinds.

We also have ongoing initiatives to improve our toy regulations, including dangers posed by small, powerful magnets; to address infant bath seats, potentially to regulate them; to improve our already world-leading regulations for cribs, cradles, and bassinets; and to review potential standards for ski helmets. Most of all, we are looking forward to the passage of the Canada Consumer Product Safety Act and to the changes the legislation will bring to product safety in Canada. We are hopeful that our focus will soon turn to implementation of that legislation.

Thank you, Madam Chair.

[The Chair, Conservative, Joy Smith]

Thank you.

We'll now go to Pamela Fuselli.

[Pamela Fuselli, Executive Director, Safe Kids Canada]

Thank you for the opportunity to speak today and to share Safe Kids Canada's views on injury prevention, focusing on our area of expertise: children and youth. We're extremely pleased to see that the committee on health is undertaking a study on this important public health issue.

Our vision is fewer injuries, healthier children, a safer Canada. Our mandate is to lead and inspire a culture of safety through the implementation of evidence-based strategies, healthy public policy, and education.

In Canada, unintentional injury remains the leading cause of death among children ages one to 14, more than any other cause. The top causes of death for Canadian children and youth are largely preventable. These include motor vehicle crashes, threats to breathing, drowning, pedestrian injuries, poisoning, falls, and a multitude of injuries in homes.

The numbers are revealing. In 2004, the latest year for which this information is available, unintentional injuries for all ages cost Canada's health care system approximately $19.8 billion in direct system and in direct costs annually. Approximately $4 billion are specifically related to unintentional injuries in children and youth.

On average, the equivalent of one classroom per month of children aged 14 and under are killed in Canada each year, another 60 are hospitalized for serious injury each day, and hundreds of thousands are seen in emergency departments every year.

The prevalence of injuries in Canada is alarming, and this number is staggering, yet consider that many experts believe that these numbers significantly underreport the true burden. Some estimate that five to ten times that number of children and youth suffer severe trauma and preventable injuries every year.

Injuries are not acts of fate or accidents. They do not have to happen. The majority of injuries are predictable and preventable. Bumps and scrapes may be a part of childhood, but serious injury resulting in death or lifelong disability is something that no child and their family should have to bear. Many of those who survive serious injury are left with disabilities, both physical and emotional. This stress on the child and their family and the community cannot be underestimated. Lost time at school for children and at work for their parents is just the tip of the iceberg.

In 2007 the World Health Organization strongly recommended its member countries develop and implement national injury prevention strategies. Canada can become an international leader in injury prevention. On March 3, 2010, in the Speech from the Throne, then Governor General Michaëlle Jean read the following statement:

To prevent accidents that harm our children and youth, our Government will also work in partnership with non-governmental organizations to launch a national strategy on childhood injury prevention.

Safe Kids Canada issued a media release encouraging this commitment to strategic action. This announcement was an important first step for the Government of Canada, and it lays the critical foundation for achieving progress in one of the most pressing health issues faced by our country, but more action is needed.

Health professionals, researchers, private sector leaders, not-for-profit organizations, and Canadian families have long awaited a coordinated approach that mobilizes their collective experience and knowledge to prevent the devastating lifelong changes that injuries place on children every day in this country.

In order to accomplish a substantial reduction in preventable injuries and loss of life due to injury among Canadian children and youth, Safe Kids Canada calls for the establishment of a national injury prevention strategy, a strategy that must include surveillance, measurement, leadership, adoption of healthy public policy, educational activities, and environmental changes.

The public health network's injury prevention and control task group, of which we are a member, developed a vision statement to frame and guide its work, which included the following: we see a Canada where injury is understood to be predictable and preventable, where governments, business leaders, and academics work together to ensure healthy public policy, enhance community capacity, support individual skills, and take all appropriate action to reduce the likelihood of injury and death; we see a Canada where an injury-causing event, when one occurs, is not dismissed as fate but seen as an important opportunity to learn, where important new knowledge and best practices for prevention are generated and translated into effective action; we see a Canada that enjoys the lowest rates of injury of any nation in the world.

Canada's children and youth do not enjoy the health that Canada is capable of providing. Injury is not seen as an indicator of child health, as it should be. Comparative data with other countries suggest that market improvement is both achievable and necessary. Canada ranks 18th out of 26 international OECD countries in terms of injury and mortality for children and youth. There's an urgent need for a strategic approach to injury prevention in Canada.

I will conclude with one final thought from a recent report issued by the Canadian Institutes of Health Research. In Canada there are more than five million women of child-bearing age, and their children will add to the eight million children and youth in Canada who represent the future of our country. An implemented national strategy can keep the future of Canada safe.

Thank you.

[The Chair, Conservative, Joy Smith]

Thank you very much.

We'll now go into our first round of Qs and As for seven minutes. We'll start with Dr. Duncan.

[Kirsty Duncan, Liberal, Etobicoke North, ON]

Thank you, Madam Chair, and thank you to all the witnesses for coming.

I'm really concerned about suicide in first nations and in our Inuit youth. I'm wondering, what is the actual rate per hundred?

[Jane Billings]

We brought large tables of stats, so we'll just look that up.

[Kirsty Duncan, Liberal, Etobicoke North, ON]

Well, maybe I'll go on. What's the last year we have data for?

[Sylvain Segard, Director General, Centre for Health Promotion, Public Health Agency of Canada]

That would be 2004.

[Kirsty Duncan, Liberal, Etobicoke North, ON]

So 2004, for tracking suicide in first nations and Inuit...?

How do the rates compare internationally? I know the World Health Organization has been concerned about suicide in our communities.

[Jane Billings]

The suicide rates for our aboriginal youth, especially on reserve, are significantly higher than those in the rest of Canada and also of other countries. It is not a story we're proud of.

We're working actively with the First Nations and Inuit Health Branch in Health Canada. We're working actively from the Public Health Agency with them on interventions and programs that may work, that may help to bring down the suicide rates. There have been some very successful examples, largely by giving the youth hope, by improving the governance in the communities, by giving them a future and alternatives. But it is not a short process.

[Kirsty Duncan, Liberal, Etobicoke North, ON]

No. Perhaps you could table with the committee what the actual rates are.

How long have we known that suicide was higher in these communities? When did we actually know this? And how long have we been tracking this information?

[Jane Billings]

That's information that we'll have to get from the First Nations and Inuit Health Branch. We've been tracking, though, for at least a decade. And we've known it's been higher for some years, for that point in time. But we can get you the exact dates from FNIHB.

[Kirsty Duncan, Liberal, Etobicoke North, ON]

Okay. I'm concerned that we don't have anything past 2004, when this is such a serious problem.

Could you table with this committee all programs that have been developed to specifically target reducing suicide in communities, and against that, how suicide...? Is it increasing? Is it decreasing? How is it changing? And then, what have we invested, and where? I guess I want to know where, going forward, these investments have to be made in order to get real change.

[Jane Billings]

The First Nations and Inuit Health Branch has a very significant program directed towards aboriginal suicide and health promotion among aboriginal youth. So we will provide you with the information on that program.

[Kirsty Duncan, Liberal, Etobicoke North, ON]

Thank you.

I'm wondering if I could ask Ms. Fuselli what the leading causes are of unintentional injuries in youth adolescents in Canada and how this data compares internationally.

[Pamela Fuselli]

The leading causes of death to children and youth in Canada.... We're talking about under 14 years with this data set. Drowning is the leading cause, then motor vehicle crashes, followed by suffocation. And they're fairly close: drowning, 15%; motor vehicle, 14%; and suffocation, 13%. In terms of hospitalization, falls are the overwhelming cause of hospitalization for children and youth: 37% of hospitalizations.

[Kirsty Duncan, Liberal, Etobicoke North, ON]

What would be your top three recommendations to reduce drowning?

[Pamela Fuselli]

For drowning, you have to look at the different age groups for very young children. Bathtubs are the location where we see a lot of the drownings happening, so it's supervision and educating parents that not even for a second can they leave the room to answer a phone or grab a towel. The use of bath seats provides a false sense of security, so it's not to use those as a device, if at all; people put their children in bath seats and feel like they can run out for just a second, when in fact that's not the case.

For older kids, it's backyard pools, especially in urban areas. The best evidence that we have from research right now is for four-sided pool fencing with a self-closing, self-latching gate. What that means is that the home currently, in most bylaw,s forms the fourth side of the pool enclosure, which means that any children living or visiting those homes can gain access to the pool because there is no fence between the house and the pool with a gate. The scenario that we see most often is children drowning in their backyard pools when they're not meant to be swimming, so this isn't during a swimming event generally. They're gaining access to the pool from the home.

[Kirsty Duncan, Liberal, Etobicoke North, ON]

What federal action would you like to see to help reduce drownings in this country?

[Pamela Fuselli]

I would like to see a comprehensive four-sided pool fencing bylaw across the country. We have sporadic bylaws, municipal and provincial, at this point, but I would like something that's comprehensive and standard across the country. Certainly, education around the priority that drowning is one of the leading causes of death.... I don't think most people know that.

[Kirsty Duncan, Liberal, Etobicoke North, ON]

Education is provincial, but swimming used to be a pretty significant part of grade 3 education, for example. I consider it one of the life skills. How do you feel about teaching swimming as a life skill?

[Pamela Fuselli]

I think it's part of that comprehensive approach. I think both parents and children should know how to swim. Parents should actively supervise the fences, obviously, which is a big intervention that works. Also, knowing how to get emergency care if something occurs.... We call it layers of protection, so you have a number of these different mechanisms in place to reduce drowning.